Children were seen to be placed “at risk of harm” and patients waiting more than three hours to be assessed during a health inspection at Boston Pilgrim Hospital’s emergency department, it has been revealed.

An unannounced Care Quality Commission inspection of Pilgrim Hospital found “unsafe” and “unreliable” systems in place in its emergency department, as well as failures to prioritise patients.

Issues spotted by CQC inspectors on November 30 include a child with potential sepsis who was not prioritised immediately.

A report by Amanda Stanford, Deputy Chief Inspector of Hospitals in the Central Region, says the ward was “under adverse pressure” when it carried out the inspection.

Comments from Ms Stanford’s report include: “Despite the department being under extreme pressure at the time of our inspection we saw no action taken to assess medical staffing levels were sufficient to meet the increasing capacity, demand or patient acuity issues. We heard how some doctors had not had a break for the entire 12-hour shift.

“We saw patients such as a patient with a diabetic ketoacidosis (DKA) categorised as a category three when they should have been categorised as category one (immediate priority). We also saw a child with potential sepsis was also categorised as a category three when they should have been categorised as category one (immediate priority).”

Several key issues also included:

* Patients waiting more than three hours to be assessed

* Patients remaining in ambulances for 20-65 minutes, with no system in place to prioritise them

* Critical observations being overdue by “significant time periods”

* Staff not commencing treatment in a timely way

* An unstructured approach to patient flow

* An ineffective Rapid Assessment and Treatment process

* Patients receiving care in corridors

* An insufficient staffing level and skill mix to meet the needs of patients

* Children placed at risk of harm because they were not cared for by nursing staff with the necessary competencies to provide safe and effective care.

* Ineffective leadership within the department

* A culture of blaming overcrowding and low staffing levels/recruitment and use of agency staff for poor compliance with safety measures and poor practice.

The trust’s newly created Integrated Assessment Centre had an empty bed for three hours and insufficient clinical staff.

In a statement, United Lincolnshire Hospitals Trust Director of Nursing Michelle Rhodes, has acknowledged that the report “will be upsetting for our patients, public and staff to read”.

She added: “We would like to apologise to any patients who have not received the high quality care we would expect.

“This report by the CQC makes very difficult reading for all of us and we fully accept their findings. This is a position none of us want to be in.

“We have been concerned for some time about the challenges faced at Pilgrim A&E, and had escalated it earlier this year.

“Providing safe, compassionate, patient-centred care is always our priority, but we know that A&Es across the country are struggling with large numbers of patients and shortages of staff, and these things acutely affect Pilgrim hospital.”

She said a number of the issues were already addressed and highlighted a further £800,000 investment in staffing and support.

She said individual cases mentioned in the report had been fully investigated.

“As a result of the work we have been doing over the last few weeks, we are confident that the service is more resilient, and with the continuing support from our partners we will build on this progress to help secure it further over the winter period,” she said.

Healthwatch Lincolnshire is concerned for patient safety in this department and has even suggested people avoid the department in favour of alternative centres.

Whilst the patient watchdog recognises that increased patient demand and staffing numbers significantly impact on the department, they say there are also some factors which need to be addressed by the whole health and care system both in Lincolnshire and national leadership.

Sarah Fletcher, Healthwatch Lincolnshire Chief Executive Officer said: “On behalf of Healthwatch and more importantly patients needing to use this service in Lincolnshire, we hope that the entire NHS, social care and other leaders including our MPs all pull together to support United Lincolnshire Hospitals Trust in turning around Pilgrim Hospital’s Emergency Department as this is such a vital resource for people living in East Lincolnshire”.

Mrs Fletcher went on to say: “As patients, we can also do our bit to help as a significant number of people are still attending the Emergency Department instead of seeking support from other services like the minor injury units, nurse practitioners as well as a doctor at their GP Practice, local pharmacies or NHS 111 who may refer them to the out of hours doctor for instance”.

“We would urge residents to consider if their problem is a real ‘here and now’ emergency or something that they could seek help from one of the above and wait a few days. However, anyone who is experiencing what they believe to be a health emergency should always telephone 999”.

She said areas highlighted in the report such as staff training where there is insufficient capacity to release staff, and cultures where patients not being assessed in a timely way were “concerning”. Adding that it was clear that staff are under extreme pressure and fatigue which can often lead to errors.

If a health emergency does arise and patients are able to travel to another hospital such as Lincoln, King’s Lynn, Peterborough, Leicester, Nottingham, Scunthorpe, Grimsby or Hull rather than Pilgrim then Healthwatch Lincolnshire is recommending this as an alternative option. However, it admits many of these alternative hospitals are also facing their own overcrowding and pressures.

Healthwatch Lincolnshire is interested in hearing from anyone who has current patient experiences of Pilgrim or Lincoln Hospitals’ Emergency Department, you can contact 01205 820892 or email: info@healthwatchlincolnshire.co.uk.